This blog is totally independent, unpaid and has only three major objectives.
The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide.
The second is to provide commentary on e-Health in Australia and to foster improvement where I can.
The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.

Thursday, January 29, 2015

Budget Night was on Tuesday 13th May, 2014 and the fuss has still not settled by a long shot. Indeed more than a few commentators are now wondering out loud if the Abbot Government will last for a second term.

The modified Medicare co-payment plan - announced late last year - seems to have annoyed most other than the Government and we now wait till mid February 2015 to see what the Senate thinks of Plan B. We know the AMA and RACGP are talking to the Government and the new minister about it.

Now part of Plan B is gone but some extreme nasties still remain, i.e. the rebate cut for short consults has been abandoned the freezing of rebate levels until 2018 and a plan for a co-payment are still live.

As for the rest of the Budget - who knows and Mr Hockey is threatening tax rises to repair the Budget!

Gareth Hutchens

Treasurer Joe Hockey has warned that if Labor continues to block savings measures in the Senate he will not be able to stop Australians' income tax burden increasing through so-called "bracket creep".

"We have been warning about bracket creep and we want to deliver tax cuts, but the Labor controlled Senate continues to block savings measures that would help pay for those tax cuts," Mr Hockey told Fairfax Media.

"If Labor continues to block our savings measures the cost burden will inevitably fall on middle Australia. We do not want this to happen."

Australia's top economists, including former Treasury Secretary Martin Parkinson, have warned that middle and low-income households will face an increasing tax burden in coming years if the government does not move to prevent bracket creep.

Glenn Stevens must act fast to rescue Australia's economy

Date January 25, 2015 - 10:34AM

William Pesek

Comment

Few central bankers in modern history have had a better run than Australia's Glenn Stevens. He steered his country around the global financial crisis, drove its currency to record highs and extended its recession-free run past the two-decade mark.

That's all in jeopardy now, however, as Stevens, governor of the Reserve Bank of Australia, stands still while China's slowdown and deflationary forces close in. Markets are registering their disappointment by driving the Aussie dollar below 80 US cents for the first time since 2009. The message from traders: It's time for a rate cut. The question is, will Stevens act ahead of, or at, the central bank's February 3 policy meeting?

The odds he will are rising, but remain too low for comfort. The European Central Bank's quantitative-easing program and the Bank of Canada's surprise rate cut add to the pressure on Stevens to trim a benchmark rate he's held at 2.5 per cent for 17 months.

The most immediate danger is China, to which commodity-rich Australia has increasingly hitched its fortunes. The collapse in global commodity prices challenges Beijing's claim that its economy is growing by 7.3 per cent. Even more than the plunge in crude oil, iron ore at its lowest price in more than five years suggests China is growing slower. Such metals fuel the Chinese urbanisation trend that's been lifting world growth. As Premier Li Keqiang explained at Davos this week, China's move to a consumer-led economy from an investment-led one is real, and the fallout will be felt everywhere. China's "new normal" is particularly bad news for Australia's mining industry.

Paul Sheehan

It is not a good sign when an internationally respected economist, one of the few who predicted the 2008 global financial crisis, invokes the black plague when discussing today's global financial markets.

"We are in a world that is dangerously unanchored … We're seeing true currency wars and everybody is doing it," said William White, a senior economist for the Organisation for Economic Co-Operation and Development.

"Sovereign bond yields haven't been so low since the black plague," he told Ambrose Evans-Pritchard, the European economics editor of The Telegraph in London. Evans-Pritchard has been a prescient (and pessimistic) observer of the eurozone.

AS one health minister to another, I advise new federal Health Minister Sussan Ley to pin up in her office the words “Poor quality healthcare is always more expensive than high quality care”, and remember that the US has the lowest life expectancy in the developed world, despite spending twice the percentage of its GDP on healthcare that Australia does.

The cost of providing healthcare, particularly the acute healthcare citizens have come to expect, threatens to overwhelm budgets around the world. It is understandable that the Abbott government is trying to tackle this, albeit in an ill-thought fashion. But measures which adversely affect the quality of healthcare, especially anything that discourages people from seeing their GP, will do nothing to curb the cost of healthcare.

Federal government expenditure on Medicare this year will be about $19 billion. But this is dwarfed by the $140bn state and federal governments spend on public hospitals. To change Medicare without considering the impact on public hospitals is shortsighted.

Benjamin Veness

At 8am on Monday, in hospitals from Wagga Wagga to Sydney to Lismore, 969 new doctors will be born. We baby doctors comprise this fertile state's newest crop of interns – the largest in the country and the most in NSW's history. We are grateful for the public's trust, and also for Tony Abbott's decision while he was health minister to increase the number of medical school places, allowing many more of us to realise a dream of caring for our fellow citizens' health.

After already spending up to six years at medical school, plus this coming year of internship, deciding on a speciality will be our next big decision.

"Are you going to specialise, or just be a GP?" is a question I am often asked, but it hasn't been possible to "just be a GP" for two decades. Once, the internship was the only impediment to a new doctor hanging his or her shingle as a GP and bulk-billing Medicare for services to patients. In 1996, new federal legislation made aspiring GPs spend several more years after internship in further supervised training and exams. General practice effectively became a specialty, just like cardiology or neurosurgery.

THIS year will be a critical time for federally funded health care in Australia and many of us are wondering which direction we will take.

Will we see the dismantling of Medicare and health care services as we know them, or the rebuilding and restructuring of both the system of care and the way we finance it, to better meet the needs of all Australians?

In its first year, the Abbott government has torn down and cast aside policies and programs of the previous government and commitments it made in election mode. Central to these is the undermining of the financial base for acute care services, by the clawback of an estimated $50 billion over the next decade from the National Health Reform payments to the states and territories and the abandonment of activity-based hospital funding.

EVERYONE knows the joke about the bloke asking for directions to Dublin — I wouldn’t start from here is the punchline. When it comes to public policy, that wise Irishman has a real point.

Economists have a fancy name for it — path dependence. When considering policy options, there is no point getting a clean sheet of paper. You have to deal with what you have and tweak or modify policies, depending on your degree of political courage.

Where policy settings have been in place for long periods of time, as with Medicare, career and business decisions have been made and the electorate has built certain expectations based on their experience with the system.

Treasurer Joe Hockey has raised the prospect of people living until 150 to explain why Australians should accept cuts to government benefits and pay a greater share of their health costs.

It's kind of remarkable that somewhere in the world today, it's highly probable that a child is being born that is going to live to 150

Mr Hockey also refused to deny reports that he and former health minister Peter Dutton opposed a $20 cut to Medicare rebates for short consultations in a meeting of cabinet's powerful Expenditure Review Committee. The government abandoned the planned cut, which was due to take effect on Monday, after a revolt by doctors and Senate crossbenchers.

Lesley Russell

Adjunct Associate Professor, Menzies Centre for Health Policy at University of Sydney

The Australian Medical Association (AMA) has emerged from the recent brouhaha over the Abbott government’s proposed Medicare reforms as both a winner in the protection of doctors’ incomes and an apparent champion of the affordability of health care for patients.

Medicare changes that were due to come into effect this week would have imposed a ten-minute minimum for regular (Level B) GP consultations which currently attract a A$37.05 rebate. Consultations under ten minutes would have attracted a smaller rebate of A$16.95. GPs were faced with a choice: absorb the cuts or pass them on to patients.

The AMA framed the change as a A$20 cut to patient rebates for short visits and used data to dismiss government claims of “six minute medicine”.

No sooner had Treasurer Joe Hockey returned from his summer holiday and attempted to shape the debate about the financial challenges facing Australia, then he was subject to ridicule. The Herald thinks those attacks were unfair, and mainly confined to the more malign influences in social media. In mentioning that some people alive today may live to the age of 150, the Treasurer was not only drawing on a considerable body of medical and scientific opinion, he was discussing, in a welcome conversational style, Australia's demographic change, its dramatically aging population, and the serious national challenge this presents.

His remarks did not deserve the kneejerk opprobrium they attracted.

While Hockey has been a forceful figure in parliamentary debate, his stewardship of the Treasury portfolio has been beset by gaffes, accidents and a poorly prepared and delivered budget message.

Health and Indigenous Affairs Correspondent

The Abbott government has been accused of exaggerating growth in healthcare spending to justify cuts to Medicare rebates.

Health Minister Sussan Ley has begun consulting doctors about reforms to rein in what she has called the "rapid and unsustainable" rate of growth in Medicare spending.

While her first public act as minister was to withdraw changes that would have cut rebates for short GP visits by $20, the government still plans to cut rebates for GP visits by $5 in July, and give bulk-billing doctors the option of charging patients a fee of up to $5.

For private health insurance customers who cannot understand why their premiums are set to rise at triple the rate of inflation, the experience of CUA Health may shed some light.

The fast-growing health fund just paid out its biggest claim ever. A patient receiving end of life care in an intensive care unit just cost the fund $270,000 over a few months. “That was unique,” chief executive Philip Fraser told The Australian Financial Review. “But utilisation across the board is rising.”

In line with other insurers, CUA Health, which has 50,000 members and premium revenue of about $118 million, is facing a rise in the cost it pays hospitals and healthcare providers of “about 6.5 to 7 per cent”, he said.

Kate Hagan

Government subsidies for high-cost cancer drugs are growing at a faster rate than for other medicines, an analysis shows.

A parliamentary research paper found spending on chemotherapy rose from $84 million in 2009-10 to $586 million last financial year.

The 63 per cent annual growth in the cost of cancer drugs far exceeded that of other medicines, including those dispensed in public hospitals to manage complex conditions such as HIV/AIDS and hepatitis.

Other high-cost drugs subsidised by the government include those used to treat infertility and rare and life-threatening diseases.

Harriet Alexander, Julia Medew and Dan Harrison

In 2009, Angela Pratt was chief of staff to the health minister Nicola Roxon when the entire ophthalmological fraternity started running at them with spinning arms.

Roxon had decided to halve the Medicare rebate for cataract surgery, which still reflected the days when the procedure was lengthy and costly, though it became simple and inexpensive. Ophthalmologists were said to be earning up to $1 million a year.

Peter Sivey writes: The Abbott government is struggling with its Medicare co-payment reform, scrapping the latest version for a period of consultation, starting this week. The government claims it wants to make Medicare sustainable by controlling costs. However the proposed reforms are piecemeal and inequitable, antagonising Medicare’s stakeholders [...] without addressing underlying problems.

To recap, the revised Medicare co-payment policy as of December 9, 2014 was to reduce Medicare rebates by A$5 and encourage GPs to recoup this from patients; freeze the indexation of Medicare rebates for all doctors; and perhaps most controversially, impose a ten-minute minimum duration for level B appointments. This would have meant a A$20 rebate cut for short visits but the government scrapped this part of the plan.

Introducing demand restraints such as co-payments points to a lack of faith in the principles of universal health care and the preventive benefits of primary care. Hence they prompt outrage from the public and doctors alike who see the “slippery slope” to further increased co-payments, and reduction in government funding for public health care.

As the Abbott government casts around for a third version of its Medicare copayment policy, it’s surely time for it to ask the basic question: “Why are we doing this again?”

The reasons for abandoning the second copayment policy are clear: voters hated it; doctors were going to the barricades over it; it wasn’t going to pass the Senate; it was going to cause serious trouble for Campbell Newman’s Queensland election campaign.

In short, they were political. (And foreseeable, but that’s another story.)

But the policy reasons for cutting Medicare in the first place have been various and confusing – to return savings to the budget but also to provide money for a medical research fund, to reduce “unnecessary” visits to the doctor, to force payment from those who can afford it and to “save” the long-term future of a scheme with costs “ballooning out of control”.

So much much for all that nonsense last year about scraping off the barnacles for a fresh political start in 2015. The government has now backed down on last year’s co-payment backdown before it has even begun.

The new health minister, Sussan Ley – quite sensibly – says she wants to consult with doctors and the parliament to try to find a fair way to implement what she says are the government’s core aims: a price signal for patients who can afford to pay and continued bulk-billing for those who cannot.

It’s just a shame the government didn’t think of that in the first place, either when it announced the original across-the-board $7 co-payment, or when Tony Abbott and his then health minister, Peter Dutton, waited until after parliament had risen for 2014 to announce a complex series of changes to replace the original budget policy that had stalled in the Senate.

Gippsland doctors have expressed relief at the Federal Government's back-down on "unfair" Medicare changes that were meant to come into effect today.

Health Minister Sussan Ley announced on Thursday the government would take a measure "off the table" that would have seen general practitioners receive about $20 less in rebates for consultations that last less than 10 minutes.

Ms Ley said she became aware of "significant concerns and unintended consequences" and halted the proposal, but said it remained critical changes were implemented "to ensure quality care for Australians and a secure future for Medicare".

TONY Abbott is being urged to abandon plans to cut the Medicare rebate by $5, as government MPs warn against fighting an unwinnable political battle that plays into Labor’s hands.

Last week’s backdown on a $20 rebate cut for short GP consultations has failed to quell unrest among Liberal MPs who say the “debacle” of the government’s Medicare policy had made selling a modest co-payment politically fraught.

With the opposition and the Greens resolved to block the $5 cut to the rebate in the Senate, ­Coalition MPs say the issue will dog the government for much of the year, cruelling attempts to reset its agenda without delivering any budget savings.

THE capitulation by the government to the naked self-interest of the Australian Medical Association regarding changes to GP funding not only reaffirms the premier protection racket of the AMA but is also a profoundly disappointing missed opportunity to encourage desperately needed innovation in healthcare delivery.

Instead of the commentariat blindly accepting ludicrously ­unfounded and cataclysmic rants by GPs who seek to defend their six-minute-medicine business model, the media should foster long overdue debate about the use of highly trained and talented paramedical professionals for task substitution. If medicine can be done in six minutes, it can be done by someone else.

If a history, examination, assessment and treatment (including reasonable thinking time, discussion of options with the patient, and maybe looking things up to confirm the first opinion) can be performed in six minutes, it must be a highly standard, obvious and routine clinical encounter. This could be triaged and/or performed by trained non-doctor professionals at less cost, freeing up GPs for more complex tasks.

A PLANNED $5 cut to GP Medicare rebates could be ­restructured as the federal government gears up for crunch talks with the Australian Medical Association this week.

Health Minister Sussan Ley is scheduled to meet AMA bosses for a fresh round of consultations on the government’s vexed Medicare reforms, which the Abbott government insists are necessary to rein in the $19 billion-a-year costs.

The government still plans to introduce a $5 cut to GP ­rebates on July 1, despite opposition from Labor and the Greens who have vowed to block the reforms in the Senate amid concerns the increased cost of care will hurt the poor and increase pressure on hospital emergency rooms.

DOCTORS groups are hopeful a fresh approach by new Health Minister Sussan Ley will see the government strike a compromise on its proposed $5 cut to the Medicare rebate.

Ms Ley had her first meetings with key interest groups yesterday as she reaches out to the sector in a bid to win support for the health reforms.

As Tony Abbott urged MPs to rally behind him and to stick to the government’s “plan”, he reiterated the case for a price signal on GP visits.

“We are going to persist with injecting some more price signals into the health system. These are all sensible economic reforms as well as important long-term savings. We have our plan,” the Prime Minister told Melbourne radio.

Pharmacy Issues:

Pharmacy is pitching itself to new Health Minister Sussan Ley as the answer to Australia’s health care expenditure crisis.

In the wake of the Federal government’s backdown over the controversial Medicare cuts, the Pharmacy Guild of Australia says “full utilisation” of Australia’s community pharmacy network offers the opportunity for “better and more cost-effective health outcomes.”

The Guild says it will use the health minister’s commitment to consult stakeholders for a more sustainable Medicare, and advocate for an array of “enhanced’ pharmacy services.

Some examples of these service enhancements include:

Enhancing access to repeat prescriptions for stable, long term conditions

Extending the treatment of minor ailments to community pharmacies

Improving access to vaccinations

Post hospital and transitional care medicine reconciliation support

Basic health checks, screening and preventative health services

Mental health support

-----

Comment:

I also have to say reading all the articles I still have no idea what is actually going to happen with the Budget at the end of the day.

As pointed out on Insiders a few weeks ago the next chance to have progress in February, 2015 when Parliament comes back! Right now there is a lot of planning going on behind the scenes.